# PRAVIN J KANSAGRA MD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689987521
- **Authorized official:** PRAVIN J KANSAGRA, MD MD (OWNER)
- **Authorized official phone:** (714) 335-8570

## Contact information

- **Practice address:** 1020 S ANAHEIM BLVD, SUITE 215, ANAHEIM, CA 92805-5851
- **Practice address phone:** (714) 335-8570
- **Practice address fax:** (714) 280-0128
- **Mailing address:** 1092 S TAYLOR CT, ANAHEIM, CA 92808-2425
- **Mailing address phone:** (714) 335-8570
- **Mailing address fax:** (714) 280-0128

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | A44685 | CA | Yes |

## Other

- **Enumeration date:** 07/21/2010
- **Last updated:** 08/30/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00A446850 | BLUE CROSS | CA |
| 05 | — | 00A446850 | — | CA |
| 01 | — | 060111 | MANAGED HEALTH NETWORK | — |
| 01 | — | 1021522 | CIGNA | CA |
| 01 | — | 22139 | WINDSTONE | CA |
| 01 | — | 284863 | VALUEOPTIONS | — |
| 01 | — | 4584291 | AETNA | — |
| 01 | — | 546651409 | PACIFICARE | CA |
| 01 | — | 546651409 02 | PACIFICARE BEHAVIORAL HEALTH | CA |
| 01 | — | 796687000 | MAGELLAN | — |